The Role of Concurrent Thigh Lifts in Obese Patients With Transfemoral Osseointegrated Prostheses.

BACKGROUND

Osseointegrated (OI) prostheses are a novel alternative solution for patients with lower-limb amputations. Plastic surgeons are becoming increasingly involved in providing concurrent thigh lifts (CTLs) to reduce soft tissue redundancy around the implant. Because of limited mobility, many patients present with higher body mass indexes (BMIs) and may benefit from CTL. This study aimed to evaluate outcomes in obese patients with OI prostheses who underwent CTL compared to those who did not. Additionally, we aimed to compare outcomes in patients with normal BMIs compared to obese patients with and without CTL.

METHODS

A retrospective analysis was performed on patients who received transfemoral single-stage lower limb osseointegration between 2017 and 2023. Each patient had at least 6 months postoperative follow-up. Patients with BMIs ≥30 kg/m2 were defined as obese. Three cohorts were used for this study: patients with normal BMIs, obese patients with CTL, and obese patients without CTL.

RESULTS

The study included 80 patients (53 male, 27 female) across three cohorts: 36 patients with normal BMIs, 32 obese patients with CTL, and 12 obese patients without CTL. Obese patients with CTL experienced fewer neuroma formations, hardware failures, and soft tissue revisions compared to obese patients without CTL (P < 0.05). Furthermore, 56% of obese patients with CTL received concurrent targeted muscle reinnervation compared to 0% in obese patients without CTL (P < 0.05). Compared to patients with normal BMIs, obese patients without CTL had more hardware failures (P < 0.05). No significant differences were found in soft tissue infections, osteomyelitis, neuroma formation, limb fractures, hardware failures, or soft tissue revisions between patients with normal BMIs and obese patients who received CTL.

CONCLUSIONS

Our study results showed that obese patients with OI prostheses experienced fewer complications when they underwent CTL compared to those who did not. In addition, outcomes in obese patients with CTL were comparable to patients with normal BMIs. Our findings highlight the advantages of incorporating CTL by plastic surgeons for obese patients undergoing OI prostheses procedures.